CPEN Gastrointestinal Emergencies 2 — Questions and Answers
Question 1: A 3-year-old presents with sudden onset of inconsolable crying, drawing up the legs, and currant jelly stools. Which intervention is the priority?
- Administer IV morphine for pain control
- Prepare for air or hydrostatic enema reduction (Correct answer)
- Obtain surgical consent for immediate laparotomy
- Start broad-spectrum antibiotics
Correct answer: Prepare for air or hydrostatic enema reduction
Currant jelly stools with colicky abdominal pain are hallmark signs of intussusception, and non-surgical reduction via air or hydrostatic enema is the first-line treatment.
Question 2: An infant presents with bilious vomiting and abdominal distension within the first 24 hours of life. Which condition is most concerning?
- Gastroesophageal reflux disease
- Malrotation with midgut volvulus (Correct answer)
- Pyloric stenosis
- Hirschsprung disease
Correct answer: Malrotation with midgut volvulus
Bilious vomiting in a neonate is a surgical emergency until proven otherwise, with malrotation and midgut volvulus being the most immediately life-threatening cause.
Question 3: When performing a nasogastric lavage on a pediatric patient with suspected upper GI bleed, which finding would indicate active bleeding requiring urgent intervention?
- Clear return after 200 mL of saline
- Pink-tinged return that clears after lavage
- Persistent bright red blood despite lavage (Correct answer)
- Coffee-ground material that clears with lavage
Correct answer: Persistent bright red blood despite lavage
Persistent bright red blood despite gastric lavage indicates active, ongoing hemorrhage requiring urgent endoscopy or surgical intervention.
Question 4: A 7-year-old with known short bowel syndrome presents with high-volume watery diarrhea, fever, and abdominal cramping after starting a new enteral formula. What is the most appropriate first action?
- Administer loperamide to slow GI transit
- Hold the enteral feed and assess for formula intolerance or infection (Correct answer)
- Increase IV fluid rate and continue enteral feeds
- Order a barium enema
Correct answer: Hold the enteral feed and assess for formula intolerance or infection
High-volume diarrhea with fever in a child with short bowel syndrome warrants stopping enteral feeds and evaluating for infection (including C. difficile) or formula intolerance before resuming.
Question 5: Which electrolyte abnormality is most commonly associated with prolonged, forceful vomiting in an infant with pyloric stenosis?
- Hyperkalemic metabolic acidosis
- Hypokalemic hypochloremic metabolic alkalosis (Correct answer)
- Hypernatremic metabolic acidosis
- Hyponatremic metabolic acidosis
Correct answer: Hypokalemic hypochloremic metabolic alkalosis
Repeated loss of hydrochloric acid and potassium through vomiting in pyloric stenosis causes hypokalemic hypochloremic metabolic alkalosis.
Question 6: A 5-year-old presents with sudden, severe periumbilical pain that migrates to the right lower quadrant, low-grade fever, and anorexia. The Rovsing sign is positive. Which diagnostic tool is preferred to confirm the diagnosis while minimizing radiation exposure?
- Abdominal X-ray
- CT scan of the abdomen and pelvis
- Ultrasound of the right lower quadrant (Correct answer)
- MRI of the abdomen
Correct answer: Ultrasound of the right lower quadrant
Ultrasound is the preferred first-line imaging for suspected appendicitis in children to avoid ionizing radiation, with CT reserved for indeterminate ultrasound results.
Question 7: A 10-year-old with Crohn disease presents to the ED with severe right lower quadrant pain and a palpable tender mass. Imaging reveals a periappendiceal abscess. What is the initial management?
- Immediate appendectomy
- IV antibiotics and interventional radiology-guided drainage (Correct answer)
- Oral antibiotics and outpatient follow-up
- High-dose corticosteroids
Correct answer: IV antibiotics and interventional radiology-guided drainage
A periappendiceal abscess in pediatric patients is typically managed initially with IV antibiotics and percutaneous drainage, with interval appendectomy considered later.
CPEN Gastrointestinal Emergencies 2
A 3-year-old presents with sudden onset of inconsolable crying, drawing up the legs, and currant jelly stools.
Which intervention is the priority?